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See a sample rate comparisonCPT 55040 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Excision Of Hydrocele; Unilateral
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Male Genital System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 55040 |
| Medicaid Fee Schedule | View Medicaid rates for 55040 |
National average reimbursement for CPT 55040 by major payers:
$442.74
$451.41
$506.78
$558.05
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CPT 55040
5 of 25 sample ratesHigher to lower in this preview
Port Warwick Surgery Center, LLC
Port Warwick Surgery Center LLC
$7,347.00Published rateGeorgia Interventional Pain
$2,350.00Published rateNorthwest Eyelid And Orbital Specialists Ps, Neos Surgery Center
Northwest Eyelid And Orbital Specialists Ps
$1,737.00Published rateSkypark Surgery Center LLC
$1,155.00Published rateCenter For Endoscopy Inc
$640.00Published rate
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See a sample payer proposalCPT 55040 vs. Other Surgical Procedures on the Male Genital System Codes
The CPT 55040 code is part of the Surgery services used for Surgical Procedures on the Male Genital System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 55040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 54901-CPT | High | Surgery To Reverse Vasectomy, Surgery To Remove Or Bypass A Blockage In The Flow Of Sperm And Semen Through The Genital Structure. The Procedure Involves The Epididymis And Vas Deferens On One Or Both Sides. |
| 55000-CPT | Low | Punctur Aspirat Of Hydrocele Tunica Vaginalis W//W/O In, Puncture Aspiration Of Hydrocele Tunica Vaginalis With Or Without In |
| 55040-CPT | Moderate | Excision Of Hydrocele; Unilateral |
| 55041-CPT | Moderate | Excision Hydrocele Bilateral |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 55040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 55040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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